Advice - Low Supply & Latch Issues (Using Nipple Shields)

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I had a pretty challenging delivery where I lost a significant amount of blood. This impacted the colostrum I produced. I also had latch issues while in hospital (4 days) and proceeded to formula feed as my iron levels (required iron transfusion) were so low that I didn’t have energy to keep attempting to match an agitated baby. The midwives tried to “help” by forcing him onto my breast, but it didn’t work.

5 days PP in the morning my right breast leaked and I thought this was an encouraging sign. That same day, I had a lactation consultant come to the house and she and I were able to get baby latch, but it was still a challenge. She did indicate that as a last resort, I could use nipple shields, as supply was critical.

I have been using nipple shields and still attempting to have baby latch (more unsuccessful than not), but I’m finding the baby nurses 20-25 min each side (40-50 min of breastfeeding), but gets frustrated closer to the 25 min mark and wants off. Baby then continues to cue for more milk, so I have been topping up with formula but have been told I shouldn’t be doing this as it will lead to baby becoming disinterested in the breast. Instead, I was recommended to express every 3-4 hours (so almost as often as feeding).

I’m very much struggling as this leaves me with almost no time to sleep and leaving me tired, especially as I had no sleep in the hospital and my iron levels are still low, but improving.

Has anyone been in this situation? If so, what did you do?

I've been in a similar situation. The main question is what do you want to do from a feeding point of view? If you want to exclusively breastfeed you will need to pump to ensure a supply is there while you work on the latch. The best thing for supply is baby feeding directly but only if they're effectively removing milk and a poor latch may mean that they are not so that's where the pump can be useful. Regular pumping is very hard work though and can be quite destructive to a new mum's mental health as it's a lot to fit in, especially if you're also feeding directly.

So if you're not fussed on exclusive breastfeeding but would like to try and breastfeed for some of the time you can take a more relaxed approach with formula top ups etc. I personally combi feed because of low supply issues. I pumped twice a day for the first 8 weeks (after a feed) but even that was exhausting with a clingy newborn and a toddler so I stopped at 8 weeks. I offer breast first and then top up with formula during the day and just breastfeed at night. It works for us. I also use nipple shields as i was in pain without and she's used to latching with them now.

Have you had someone look at the latch and look for a tongue tie? A lactation consultant would be helpful, especially if you want to try to exclusively breastfeed.

In a similar situation, I directly fed then pumped and topped up with expressed milk in a bottle. Eventually as baby got stronger and was better able to latch and feed, I stopped the pumping. I did take a good month. extremely hard work but I wanted to EBF.

I’m definitely going to be combination feeding as it gives my husband the ability to be involved in feeding/give me a chance to have an extended sleep before night shift.

I have been breastfeeding and topping up with formula during the day then I tried only breastfeeding at night, but it clearly wasn’t enough as he wouldn’t sleep so I had to add in a formula feed too. I’m expressing too, but the idea of expressing after every feed is just mentally exhausting. Do you breastfeed both sides when you’re combination feeding? I’ve been feeding 20-30min each side, but is an hour excessive?

The lactation consultant insists I’ll lose my supply if I don’t express, but this seems extreme? She also doesn’t think he’s tongue tied, but I may get a second opinion.

You don’t time bf, you allow baby to fully drain one side and let him/her come off themselves (they know when they’re full), then switch to other side.

do you mean baby doesn’t sleep at all when bf at night, or doesn’t sleep for long? The latter is normal!

No bf or pumping at night will compromise your supply as the hormones to make milk are highest at night and you need to feed to stimulate the milk production

I plan to BF at night then top up with formula. Expressing on top of this has been very exhausting.

I’ve found that he fall asleep on the breast but not too long into feeding. He will still continue on the same breast before I move to the other one.

Baby maybe stays on in his next to me bed for maybe 20 minutes and then cries. We can’t seem to get him to settle inside - we even put his moses basket in the crib to make it seem smaller.

How old is your baby?

11 days

I’m my experience this is all very normal. Bf babies don’t sleep for long periods at all and it does take a good couple of months for them to settle better/in their crib/cot. I know this isn’t helpful and you must think how am I supposed to cope, but somehow you find a way. Can your partner help with other things like cooking, cleaning etc or soothing/holding baby straight after a feed so you can sleep?

I only have experience of exclusive bf. Hopefully someone else can advise on combo feeding. Not sure how you ensure you build a supply (so that baby is satisfied) whilst also formula feeding (because formula replaces a feed and that means the stimulus for milk production is removed for parts of the day).

Yes I always BF both sides and I let mine feed until they come off themselves if possible which does make for long feeds! You can switch breasts back and for and change the nappy between breasts to keep them awake and feeding when little. I find this much less of an issue now mine is older.
To avoid losing supply I always breastfed first before offering formula so that stimulation was there just as often as if I was EBF. Rather than replacing a whole feed.
At such a young age I agree that waking lots in the night doesn't necessarily mean they're not getting enough breast milk. I fed exclusively for 4 weeks at first and that was a lot of feeding.

It sounds he's doing well and just adapting to life outside the womb , having to learn to feed when it was previously done for him!
When he doesn't settle after a feed he may need to suck - this is a natural newborn reflex hence why dummies are manufactured and used.
If you let him suck your finger (with the padded but turned up to the roof of his mouth) does it calm him? You may need to persevere a bit but it may settle him. If he does I would hold off the top up.
The frequency feed/sleep cycle is normal. His stomach is still tiny so empties quickly.
Be reassured if he is having plenty of wet and dirty nappies.
Combi feeding is good as long as you have established a good breastfeeding regime. It obviously works best with fewer bottles. They tend to gravitate to a bottle preference as it's much easier for them.

I had very similar issues with my first, and was clearly not making enough milk as he wasn't putting on weight.

On the advise if my (excellent) health visitor I started just topping up feeds with formula, then would use a bottle for the last evening feed. This seemed to allow my body to fill up my reserves and make milk overnight.

You'll hear a lot of criticism of mixed / combo feeding, where for me it allowed me to carry on BF for about 75% until my baby was 10 months.

Are you sure he’s hungry as opposed to just a newborn baby that doesn’t want to be in the crib? Sounds like he’s feeding a decent amount of time and if you’re not constantly engorged then sounds like he’s taking a decent amount or milk. How is his weight gain and nappy output?

I would try ditching the formula and just keep putting to boob. It’s knackering but unfortunately until supply levels out you do just need to keep putting to boob. Any formula feeds or expressed milk feeds you will need to then pump to keep up the supply. Can you feed in bed and Co sleep? That’s what I’ve done for both of mine.

was the lactation consultant nhs or private?

Thanks everyone for your input.

As of day 10 he was above his birth weight birth weight was 3.5 kg and when measured was 3.6 kg, so he’s feeding well with the combination approach.

We reluctantly introduced a dummy as we thought he just wanted to suck on something. We tested this out one night when I breastfed him and topped him up with 15-20 ml of formula. He didn’t want the dummy right away and upon giving him 50 ml more formula, he was finally satisfied and came off the bottle.

I find that when I express after feeding, I’m producing about 15-20 ml of breast milk in each breast. Does this sound normal or abnormal?